April 08, 2009

What is a psychopath?

by Joye C. Anestis

"People fake a lot of human interactions, but I feel like I fake them all, and I fake them very well. That's my burden, I guess.""She's the only person in the world who loves me. I think that's nice. I don't have feeling about anything, but if I could have feelings, I'd have them for Deb." - Dexter Morgan, Showtime's resident psychopath on Dexter
(played by Michael C. Hall)

In my mind, few clinical constructs are more interesting, or more enigmatic, than that of psychopathy. Psychopaths have held public interest for decades - countless movies (e.g., The Silence of the Lambs), books & plays (e.g., Scarlett O'Hara in Gone With the Wind), and television shows (e.g., the aforementioned Dexter, as well as the exceptional The Wire) have been written featuring fictional and non-fictional psychopaths. And how can we not be fascinated by people who are so emotionless, so narcissistic, and yet so charming? Psychological literature has a lot to say about psychopaths - who they are, why they do what they do - and this article begins a series where I will discuss several domains of psychopathy. Today, I am only concerned with defining psychopathy.

The psychological literature diverges on how best to define psychopathy. Hervey Cleckley (1941/1988) is credited with one of the original (and best) definitions of psychopathy. In his classic text, The Mask of Sanity, he describes psychopathy as a conglomeration of 16 personality characteristics (see Cleckley, 1941/1988, pp. 337-364 for a full explanation of these characteristics):

Thus, Cleckley paints an enduring picture of an individual who is callous, unemotional, self-centered, & charming, who to the world displays a facade of excellent overall mental health. Hopefully, I haven't just described anyone you know! I always find it interesting that Cleckley really de-emphasizes antisocial behavior in his description of psychopathy. Popular culture would have us believe that criminal activity is the predominant symptom of this syndrome, but Cleckley originally argued that it was a minor part of the overall presentation (only 1 of his 16 characteristics addresses antisociality). Despite Cleckley's emphasis on a personality-driven conceptualization of psychopathy, much of today's psychopathy research investigates the presence of specific antisocial acts, in conjunction with or in lieu of personality traits (see the work of Robert Hare as the best example). In future posts, I will discuss research findings which validate most of Cleckley's psychopathic personality characteristics, as well as some of the behavioral symptoms that have been investigated.

The integration of behavior into the personality-driven definition of psychopathy leads us into a discussion on what psychopathy is not, namely psychopathy is not antisocial personality disorder (ASPD). Symptoms of ASPD are marked by illegal & irresponsible behaviors that are present in childhood and persist through adulthood (APA, 2000). The symptoms of ASPD are all behavioral, making this a very reliable diagnosis to make. Interestingly, the current ASPD definition was derived from earlier definitions which included some of the personality-driven traits of psychopathy. So ASPD began as a more global definition of psychopathy but has changed into a different, albeit very related, construct. How related are ASPD & psychopathy? Hart & Hare (1989) report that a diagnosis of psychopathy in a sample of incarcerated males was highly
predictive of ASPD but a diagnosis of ASPD was not predictive of psychopathy. Prevalence studies suggest that up to 70-80% of prison inmates meet criteria for ASPD but only 20% display elevated psychopathic traits (Hare, 1998). In other words, in incarcerated samples (argued by some to be the most appropriate sample on which to study psychopathy), psychopathy is rare and ASPD is common, most incarcerated psychopaths meet DSM-IV criteria for ASPD but most incarcerated individuals with ASPD are not psychopaths. (It is important to note that these 2 studies used incarcerated samples. I'll discuss in a future post what we know about psychopaths who have eluded incarceration, individuals known as "successful" psychopaths.)

I also want to comment briefly on the use of the term "sociopath." This was a popular term for the psychopathy construct in the mid-20th century. DSM-I (1952) included a sociopathic personality disturbance, described as a problem in the relationship between "society & of conformity with the prevailing cultural milieu, and not only in terms of personal discomfort and relations with other individuals" (p. 38). The term "sociopath" has not been used in mainstream clinical psychology since 1968 when sociopathic personality was replaced with personality disorder, antisocial type, in DSM-II. So don't get confused when people start talking about sociopaths...they are just using an older term for what we know as psychopaths.

The psychopathy literature is very large and very diverse. In future posts, I will write about the treatment of psychopathy (if such a treatment even exists), neurochemical & physiological differences found in psychopaths, the development of psychopathy, sex differences in psychopathy, and the "successful" psychopath, just to name a few. As always, if there are specific topics you want me to cover, please let me know at joyeanestis@psychotherapybrownbag.com.

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What is a psychopath?

by Joye C. Anestis

"People fake a lot of human interactions, but I feel like I fake them all, and I fake them very well. That's my burden, I guess.""She's the only person in the world who loves me. I think that's nice. I don't have feeling about anything, but if I could have feelings, I'd have them for Deb." - Dexter Morgan, Showtime's resident psychopath on Dexter
(played by Michael C. Hall)

In my mind, few clinical constructs are more interesting, or more enigmatic, than that of psychopathy. Psychopaths have held public interest for decades - countless movies (e.g., The Silence of the Lambs), books & plays (e.g., Scarlett O'Hara in Gone With the Wind), and television shows (e.g., the aforementioned Dexter, as well as the exceptional The Wire) have been written featuring fictional and non-fictional psychopaths. And how can we not be fascinated by people who are so emotionless, so narcissistic, and yet so charming? Psychological literature has a lot to say about psychopaths - who they are, why they do what they do - and this article begins a series where I will discuss several domains of psychopathy. Today, I am only concerned with defining psychopathy.

The psychological literature diverges on how best to define psychopathy. Hervey Cleckley (1941/1988) is credited with one of the original (and best) definitions of psychopathy. In his classic text, The Mask of Sanity, he describes psychopathy as a conglomeration of 16 personality characteristics (see Cleckley, 1941/1988, pp. 337-364 for a full explanation of these characteristics):

Thus, Cleckley paints an enduring picture of an individual who is callous, unemotional, self-centered, & charming, who to the world displays a facade of excellent overall mental health. Hopefully, I haven't just described anyone you know! I always find it interesting that Cleckley really de-emphasizes antisocial behavior in his description of psychopathy. Popular culture would have us believe that criminal activity is the predominant symptom of this syndrome, but Cleckley originally argued that it was a minor part of the overall presentation (only 1 of his 16 characteristics addresses antisociality). Despite Cleckley's emphasis on a personality-driven conceptualization of psychopathy, much of today's psychopathy research investigates the presence of specific antisocial acts, in conjunction with or in lieu of personality traits (see the work of Robert Hare as the best example). In future posts, I will discuss research findings which validate most of Cleckley's psychopathic personality characteristics, as well as some of the behavioral symptoms that have been investigated.

The integration of behavior into the personality-driven definition of psychopathy leads us into a discussion on what psychopathy is not, namely psychopathy is not antisocial personality disorder (ASPD). Symptoms of ASPD are marked by illegal & irresponsible behaviors that are present in childhood and persist through adulthood (APA, 2000). The symptoms of ASPD are all behavioral, making this a very reliable diagnosis to make. Interestingly, the current ASPD definition was derived from earlier definitions which included some of the personality-driven traits of psychopathy. So ASPD began as a more global definition of psychopathy but has changed into a different, albeit very related, construct. How related are ASPD & psychopathy? Hart & Hare (1989) report that a diagnosis of psychopathy in a sample of incarcerated males was highly
predictive of ASPD but a diagnosis of ASPD was not predictive of psychopathy. Prevalence studies suggest that up to 70-80% of prison inmates meet criteria for ASPD but only 20% display elevated psychopathic traits (Hare, 1998). In other words, in incarcerated samples (argued by some to be the most appropriate sample on which to study psychopathy), psychopathy is rare and ASPD is common, most incarcerated psychopaths meet DSM-IV criteria for ASPD but most incarcerated individuals with ASPD are not psychopaths. (It is important to note that these 2 studies used incarcerated samples. I'll discuss in a future post what we know about psychopaths who have eluded incarceration, individuals known as "successful" psychopaths.)

I also want to comment briefly on the use of the term "sociopath." This was a popular term for the psychopathy construct in the mid-20th century. DSM-I (1952) included a sociopathic personality disturbance, described as a problem in the relationship between "society & of conformity with the prevailing cultural milieu, and not only in terms of personal discomfort and relations with other individuals" (p. 38). The term "sociopath" has not been used in mainstream clinical psychology since 1968 when sociopathic personality was replaced with personality disorder, antisocial type, in DSM-II. So don't get confused when people start talking about sociopaths...they are just using an older term for what we know as psychopaths.

The psychopathy literature is very large and very diverse. In future posts, I will write about the treatment of psychopathy (if such a treatment even exists), neurochemical & physiological differences found in psychopaths, the development of psychopathy, sex differences in psychopathy, and the "successful" psychopath, just to name a few. As always, if there are specific topics you want me to cover, please let me know at joyeanestis@psychotherapybrownbag.com.

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